Gastric dumping syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Umar Ahmad, M.D.[2]

Overview

Dumping syndrome may often be confused with other similar diseases that cause upper abdominal pain, nausea, and fatigue.

Differentiating Dumping Syndrome from other Diseases

Diseases with similar symptoms

• Post-gastrectomy complications:
  • Post-vagotomy diarrhea
  • Small capacity syndrome
  • Short bowel syndrome
  • Afferent loop syndrome
  • Efferent loop syndrome
• Peptic ulcer disease
• Fistula
• Adhesion
• Stenosis
• Ischemia
• Gastritis
• Internal Hernia
• Insulinoma
• Glucose-lowering medication abuse
• Symptomatic gallstone disease
• Postprandial Hypotension
• Irritable bowel syndrome (IBS)

Differentials based on nausea, vomiting, diarrhea, fatigue and abdominal pain

Gastric dumping syndrome should be differentiated from other diseases presenting with nausea, vomiting, diarrhea, fatigue and abdominal pain. The differentials include the following:

Disease	Clinical manifestations													Diagnosis		Comments
	Symptoms									Signs
	Abdominal Pain	Fever	Rigors and chills	Nausea or vomiting	Jaundice	Constipation	Diarrhea	Weight loss	GI bleeding	Hypo- tension	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging
Chronic pancreatitis	Epigastric	−	−	±	±	−	+	+	−	−	−	−	N	Increased amylase / lipase Increased stool fat content Pancreatic function test	CT scan Calcification Pseudocyst Dilation of main pancreatic duct	Predisposes to pancreatic cancer
Pancreatic carcinoma	Epigastric	−	−	+	+	−	+	+	−	−	−	−	N	↑ Alkaline phosphatase ↑ serum bilirubin ↑ gamma-glutamyl transpeptidase ↑ CA 19-9	MDCT with  PET/CT MRI	Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis (classic Trousseau's syndrome) Pancreatic panniculitis
Dumping syndrome	Lower and then diffuse	−	−	+	−	−	+	+	−	+	−	−	Hyperactive	Glucose challenge test Hydrogen breath test	Upper GI series Gastric emptying study	Postgastrectomy

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Differential diagnosis of dumping syndrome based on post-vagotomy complications:

Gastric dumping syndrome should be differentiated from other diseases presenting with weight loss, vomiting, diarrhea, and abdominal pain. The differentials include the following::

Differential Diagnosis for Postgastrectomy complications	Clinical features	Diagnosis
Short bowel syndrome	Upper abdominal pain, diarrhea, malnutrition, weight loss	LFTs, liver biopsy, Upper GI series, CT scan
Small-capacity syndrome	Early satiety, malnutrition, weight loss	Clinical diagnosis with a history of surgery
Afferent loop syndrome	Upper abdominal pain, early satiety, relief after vomiting	Ultrasound, Barium enema
Efferent loop syndrome	Upper abdominal pain, distention, vomiting	CT scan, Upper GI series
Postvagotomy diarrhea	Watery Diarrhea	Clinical diagnosis with a history of surgery

Differential diagnosis of dumping syndrome based on early dumping syndrome symptoms:

Early dumping syndrome should be differentiated from other diseases presenting with abdominal pain, vomiting, nausea and early satiety. The differentials include the following:

Differential Diagnosis for Early Dumping Syndrome symptoms	Clinical features	Diagnosis
Adhesions	Upper abdominal pain, vomiting, distention	CT scan, Upper GI series
Internal hernia	Upper abdominal pain, vomiting, early satiety	CT scan, Diagnostic laproscopy
Fistula	Upper abdominal pain, relief after vomiting, early satiety	Fistuloscopy, Endoscopy, Colonoscopy, Dye injection, CT scan
Ischemia	Upper abdominal pain, vomiting, diarrhea, distention	CT Angiography
Ulcer	Upper abdominal pain with food, nausea, acid reflux	Gastroscopy
Stenosis	Upper abdominal pain with food, nausea, acid reflux, dysphagia	Gastroscopy, Gastrografin swallow

Differential Diagnosis of dumping syndrome based on late dumping syndrome symptoms:

The differential diagnosis of dumping syndrome are based on the symptoms of early dumping syndrome such as hypoglycemia and nausea. The differentials include the following:

Differential Diagnosis for Late Dumping Syndrome symptoms	Clinical features	Diagnosis
Insulinoma	Fasting hypoglycemia	After a 72 hour fast do labs: Serum Glucose, C-peptide, Insulin, Proinsulin
Glucose-lowering medication abuse	Hypoglycemia	Sulfonylurea and C-peptide assay
Postprandial Hypotension	Nausea, lightheadedness,	Blood pressure checked before and after a meal

To review the differential diagnosis of Abdominal pain and fever, click here.